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J Korean Soc Emerg Med > Volume 30(4); 2019 > Article
Journal of The Korean Society of Emergency Medicine 2019;30(4): 355-359.
응급센터에 내원한 급성충수돌기염 환자에서 비천공성과 천공성 충수돌기염의 혈액검사 지표 비교분석
조두호 , 서정열
한림대학교 의과대학 춘천성심병원 응급의학과
Comparative analysis of unperforated and perforated appendicitis in laboratory values of patients who visited emergency center
Dooho Cho , Jeong Yeol Seo
Department of Emergency Medicine, Chuncheon Sacred Heart Hospital, Hallym University School of Medicine, Chuncheon, Korea
Correspondence  Jeong Yeol Seo ,Tel: 033-240-5220, Fax: 033-240-5446, Email: siris94@hallym.or.kr,
Received: October 20, 2018; Revised: October 24, 2018   Accepted: October 26, 2018.  Published online: August 30, 2019.
ABSTRACT
Objective:
Unperforated and perforated acute appendicitis need to be differentiated because appendicitis with a free perforation requires an emergency operation to prevent contamination inside the bowel from spreading into the peritoneal cavity. The sensitivity of imaging tests is not reliable enough alone for determining the existence of a perforation. The aim of this study was to determine the differences in laboratory values between unperforated and perforated acute appendicitis to help distinguish perforated acute appendicitis.
Method:
The laboratory values and demographic data of a total of 175 patients who visited the emergency room and were diagnosed with acute appendicitis were collected. The time elapsed from symptom presentation to the ER visit, length of admission, patient demographics, and laboratory values, including sex, age, leukocyte count, neutrophil %, neutrophil count, C-reactive protein (CRP), platelet count, prothrombin time (PT), activated partial thromboplastin time, international normalized ratio (INR), serum glucose, blood urea nitrogen, creatinine, total and direct bilirubin, aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and gamma-glutamyltransferase were analyzed.
Results:
The factors associated with appendix perforations were an elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose and total bilirubin; and delayed PT and INR.
Conclusion:
Acute appendicitis patients without definite imaging evidence of the perforation but with the laboratory values suggesting a perforation, such as elevated leukocyte count, neutrophil count, neutrophil %, CRP, serum glucose, and total bilirubin; and delayed PT, and INR should raise concern for a possible undiscovered perforation.
Key words: Acute abdomen; Appendicitis; Differential diagnosis
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